How Gluten Can Destroy Your Health

What is gluten?

Gluten is a protein contained in the grains wheat, barley, rye, and oats. It is a unique protein based on its structure that lends a doughy/elastic consistency to flours derived from these grains. This is why over the centuries, gluten-containing grains have come to be used so extensively in breads and other baked goods.

How can gluten, a protein from a naturally occurring foodstuff, be harmful?

First, it must be understood that the gluten-containing grains we eat today are actually domesticated and now genetically hybridized versions of what originally were wild grasses endemic to the Tigris-Euphrates river basin. Presumably, due to pressures from shortages of other foods, or ingenuity of ancient peoples, these grasses became a source of food and calories. Thus, wheat, barley, rye, and oats are genetic derivatives of wild grass, and therefore pose the possibility that eating a wild plant may possess some toxicity.

The nature of the toxicity, although to some extent stems directly from the chemical nature of gluten, is mostly due to a reaction that occurs by the immune system of individuals in possession of certain genes that recognize gluten for the foreign protein that it is and hence toxic. The immune system genes in control of this reaction are actually not rare, and may be present in up to 60% of Americans. However, there are other, as of yet undetermined, genes that control whether or not a toxic reaction will occur, and further, whether and how much the reaction will result in damage to the intestine and other tissues. It is speculated that the structure of gluten may be similar to an infectious agent (for example a virus) and that is really why the gene is present in the immune system in the first place.

What is gluten sensitivity and how is it diagnosed?

Gluten sensitivity implies that there is an ongoing immune reaction to gluten in the diet, usually detected as antibodies against a subprotein of gluten called gliadin. Although recently these antibodies were looked for only in the blood and are found in 12% of the general American public, research has revealed that these antibodies can be detected in the stool in as many as 35% of what are otherwise normal people. If high risk patient populations are tested, or people with symptoms, the percentage usually exceeds 50%. It makes sense that the antibodies are more easily detected in the intestine because the immune system reaction to food is mainly a response occurring inside the intestinal tract. Thus, the end product of intestinal transit, stool, is the most logical place to look.

What are the symptoms of gluten sensitivity?

Although there may be no detectable symptoms of the immune response to gluten, the typical symptoms people develop occur when the reaction begins to damage the intestines. The symptoms, resulting from malabsorption or improper digestion of dietary nutrients, include abdominal bloating or pain, diarrhea, constipation, gaseousness, or nausea with or without vomiting. It appears that acid reflux in the esophagus, manifesting as heartburn, may be a potential symptom as well. Other symptoms people experience include fatigue, joint pains, mouth ulcers, bone pain, abnormal menses in women, and infertility.

How is Gluten Sensitivity Diagnosed?

In recent years, testing for gluten sensitivity and celiac sprue usually is initiated with blood tests for antibodies against gliadin, the toxic subfraction of wheat gluten, or for an antiendomysial antibody that is produced against an enzyme present in the intestine and elsewhere in the body called tissue transglutaminase. These tests have revolutionized testing for celiac sprue because they allow for detection of the syndrome before extensive irreparable damage to the intestine, bones, and other tissues has occurred. Up until recently it was thought that nearly all patients with clinically important gluten sensitivity had these antibodies detectable in blood. However, recent studies have shown that this is not true. In the early phases of the reaction, or especially when the disease is of a more mild variety, antigliadin and antiendomysial/antitissue transglutaminase antibodies may be absent from blood. Knowing that the immune reaction to gluten and other foods takes place inside the intestinal tract, extensive research has revealed that this hypothesis is not true, and has resulted in the development of new methods for detection of gluten sensitivity, celiac sprue, and other food sensitivities.

Can I have gluten sensitivity if screening blood tests for celiac sprue are negative or indeterminate?

The answer to this question is yes and is the reason we don’t test everyone for gluten sensitivity. Originally screening tests for gluten sensitivity/celiac sprue consisted of blood tests against the damaging protein in gluten called gliadin (antigliadin antibodies). However, with heightened awareness of the possibility of gluten sensitivity in family members of diagnosed Celiac, or in people with syndromes associated with celiac sprue, it has become clear that not all people suspected of being immunologically intolerant to gluten have positive blood tests. This is problematic because these individuals are told outright that they are not gluten intolerant based on negative blood tests. Many times patients themselves are able to deduce that it is wheat that causes them to feel ill or have intestinal symptoms, but when blood tests are negative they are diagnosed with irritable bowel syndrome or sometimes "wheat allergy". It is not surprising to me that blood tests in the early phase of gluten sensitivity are negative. This is because the immunologic reaction to gluten begins and occurs inside the intestinal tract and not in the blood per se. These antibodies are more frequently detected in the stool of gluten sensitive individuals rather than in the blood. This is the case based on extensive analysis of more than 500 normal people or people with various medical syndromes (including bonafide Celiac, patients with microscopic colitis, a form of colitis genetically and clinically related to gluten sensitivity, and patients with chronic diarrhea of unknown origin).

Thus, because the antibodies produced as the result of gluten sensitivity are mainly secreted into the intestine rather than the blood, analyzing stool turns up many more positive tests than blood tests. It is only when the immune reaction has been present for long periods of time and/or the process is far advanced that antibodies are produced in quantities sufficient to leak into the blood

An interesting book to read on the subject of carbohydrate digestion and a diet to treat several digestive disorders is Breaking The Vicious Cycle: Intestinal Health Through Diet, or by its old name, The Specific Carbohydrate Diet by Elaine Gottschall, B.A., M.Sc.

What is the difference between celiac sprue and gluten sensitivity?

Gluten sensitivity implies that a person's immune system is intolerant of gluten in the diet and is forming antibodies or displaying some other evidence of an inflammatory reaction. When these reactions cause small intestinal damage visible on a biopsy, the syndrome has been called celiac sprue, celiac disease, or gluten sensitive enteropathy. (Nontropical sprue and idiopathic steatorrhea are other terms that have been used for this disorder in the past.) The clinical definition of celiac sprue also usually requires that there is clinical and/or pathologic improvement following a gluten-free diet.

In the past, celiac sprue could only be diagnosed after somebody developed certain symptoms like diarrhea, weight loss, or growth failure in children. A biopsy would be performed and if abnormal and typical of celiac sprue, and if a gluten-free diet brought resolution of diarrhea, weight gain, or growth, only then would a diagnosis of celiac sprue be made. However, recent advances in diagnostic screening tests and application of these tests to people at heightened risk or to general populations have allowed detection of celiac sprue, sometimes even before damage to villi has occurred.

Figure 1 - Villi are microscopic projections which cover the intestine, greatly increasing the surface area and therefore, increasing the ability to absorb nutrients. In the latter stages of destruction of the villi, many people are diagnosed with gluten sensitivity.